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Medical Services Policy Manual, Section H

H-300 Transfer of Resources

H 310 Imposing the Penalty

4. All resources transferred for less than fair market value have been either returned directly to the client or used for the client's care; or 5. Denial of eligibility would cause an undue hardship (MS H-700). H-310 Imposing the Penalty MS Manual 01/01/19 For nursing home applicants/recipients the penalty period begins on the first day of the month of the transfer or the date on which the individual is eligible for Medicaid, whichever is the later date. Once a penalty period begins, it continues to run until expiration. (MS H-315) No penalty period will apply if the transfer can be excluded under the provisions listed in MS H-309. During the penalty period, the individual is not eligible for a vendor payment until the expiration of the penalty period but may receive other Medicaid services with the exception of Waiver services. The application must be approved for Medicaid without the vendor payment if all eligibility requirements have been met. Even though the vendor payment has been closed for nursing home recipients, Medicaid will continue to cover services not covered under the vendor payment. For Home and Community Based Services Waiver (HCBS) applicants, the penalty period begins on the date Medicaid would have been approved (MS C-200 section) if all the following criteria is met: • The applicant meets the financial and nonfinancial requirements for Medicaid eligibility; • The applicant meets the functional need (level-of-care) criteria for the waiver; • A person-centered service plan has been developed for the individual; and • A waiver slot is available for the individual’s placement. If the HCBS applicant does not meet the criteria, they are not eligible unless the individual enters a nursing facility or until the transfer date moves out of the look back period. If the individual enters a nursing facility, the penalty period will be determined and will begin when the individual meets the medical eligibility criteria and is determined Medicaid eligible. It will continue uninterrupted for the appropriate period of time even if the individual leaves and returns home. In that situation, Waiver services can resume when the penalty period is over. For HCBS Waiver recipients the penalty period begins on the first day of the month of the transfer. For both HCBS Waiver applicants and recipients, once a penalty period begins, it continues to run until expiration. (MS H-315) No penalty period will apply if the transfer can be excluded under the provisions listed in MS H-309.